Thursday, December 27, 2012

Allergies, Obesity an Open Goal for Bullies

Bullying over health issues is common, according to two studies looking at kids with food allergies and those going through weight-loss programs.

In one study, almost 32% of children with food allergies reported bullying or harassment specifically related to their allergy, often involving threats with food, Eyal Shemesh, MD, of Mount Sinai Medical Center in New York City, and colleagues found.

In a second study, 64% of teens at weight-loss camps reported weight-related victimization, not just by schoolmates but often by friends, coaches, teachers, and parents too, Rebecca Puhl, PhD, of Yale University, and colleagues reported.

Both studies appeared online in Pediatrics.

Because of the immediate and long-term physical and emotional effects, pediatricians and other clinicians should get involved in concrete ways, advised Mark Schuster, MD, PhD, of Boston Children's Hospital, and Laura Bogart, PhD, of Harvard Medical School in Boston, in an accompanying commentary.

They recommended anticipatory guidance for children and parents by describing bullying and its consequences and teaching parents how to recognize clues that it's occurring.

"In addition, clinicians can learn to recognize indicators of possible bullying such as unexplained bruises, cuts, and scratches, as well as school avoidance, social isolation, anxiety, depression, substance use, and chronic physical symptoms (e.g., headaches, stomachaches). They should be particularly alert when patients have stigmatizing characteristics that could lead to bullying (e.g., obesity, disabilities, gender nonconformity)."

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Shemesh's group analyzed surveys of 251 established food allergy patients, ages 8 to 17, and their parents at a single allergy clinic in the Enhancing, Managing, and Promoting Well-Being and Resiliency program.

Any bullying or harassment of these children was reported by 45% of them and 36% of their parents, although with poor agreement when related to reasons other than the food allergy.

Being victimized due specifically to food allergies accounted for most of these cases, with 32% of the food allergic kids and about 25% of their parents reporting such bullying.

Almost all the bullies were classmates (80%), and most bullying happened at school (60%).

The most common form was teasing (42%), followed by waving the allergen in front of the child (30%).

Notably, 12% had been forced to touch the food they are allergic to and 10% had food thrown at them.

Bullying was significantly associated with poorer quality of life scores and greater anxiety, which the researchers noted was independent of allergy severity.

While most of the bullied kids said they had told someone about what happened, parents knew in only about half of the cases.

When parents did know, though, it was associated with better quality of life and less distress in the bullied children.

To increase disclosure of bullying, "clinicians might consider asking a screening question about bullying during encounters with children with food allergy," Shemesh's group suggested.

While it's hard to compare the results with those of other studies, general population rates appear to be 17% to 35%, suggesting that food-allergic children may be bullied or harassed more than their peers, they pointed out.

"This finding, although alarming, is not surprising, given that children with food allergies have a vulnerability that can be easily exploited," they wrote.